What should be paid attention to during uterine cone biopsy?

A woman's cervix may develop many diseases. For example, if there are suspected malignant cells in the cervix, which is known as cervical cancer, this is an extremely serious disease. In order to find out the condition or treat the disease, cervical conization can be performed medically. This operation is bound to cause some damage to the cervix. In order to minimize the damage caused by the operation, you should pay attention to the following matters before and after the operation.

Cervical Conization Notes:

1. It is best to choose any day for the surgery between the end of menstruation and one week before the next menstruation.

2. Before the operation, routine blood tests and coagulation time should be performed, as well as tests for liver and kidney function, syphilis, HIV, hepatitis B two-to-half, hepatitis C, and an electrocardiogram is also required.

3. Preoperative examination of leucorrhea such as trichomonas fungi and pus cells should be performed to rule out vaginitis before surgery. Pay attention to the cleanliness of the vulva to avoid postoperative infection.

4. Avoid sexual intercourse within two months after surgery to prevent bleeding and wound infection.

5. If vaginal bleeding exceeds the amount of menstrual bleeding after the operation, you should go to the best local hospital immediately to stop the bleeding. Excessive vaginal bleeding may be life-threatening.

Cervical conization was initially performed with a scalpel (i.e., cold knife conization), which has the advantage of clear cutting edges, facilitating pathological examination. The disadvantages are that it requires hospitalization, anesthesia, a long operation time, and it is easy to bleed profusely during the operation.

Nowadays, loop electrosurgical excision procedure (also known as LEEP knife) has been widely performed. Its advantages are that it is simple and easy to perform, does not require hospitalization, and the operation time is short, only about 5 to 10 minutes.

However, whether the cutting depth of the LEEP knife is sufficient is questionable, and because the medical community has previously worried that the electric current will damage the cutting edge, the use of electrosurgical conization has not been advocated. However, after summarizing a large amount of medical practice and clinical data in recent years, it is believed that the effect of electrosurgical cone biopsy is equivalent to that of cold knife cone biopsy, and there is less bleeding. There was no significant difference in lesion clearance and recurrence between the two groups. The positive rate of cervical resection margin during cervical conization increases with the severity of the lesion. It is well known that patients with positive conization margins have a high chance of lesion progression and recurrence, but those with negative margins cannot guarantee that there are no residual lesions in the remaining cervix. The incidence of residual lesions is also proportional to the severity of the lesions, but the chance of occurrence is lower than that of patients with positive margins. Cervical gland involvement and multicentricity of lesions are the decisive factors for residual or recurrence of lesions after cone biopsy. In short, loop electrosurgical resection is the best cone cutting method because it is time-saving, simple, safe and cheap. It can be widely carried out in clinical practice.

Cervical conization in pregnant women is still controversial. Some scholars believe that cone biopsy on pregnant women may cause premature birth and low birth weight babies, while others believe that the positive rate of cutting edge and the incidence of residual lesions are high. However, most people believe that cone biopsy during pregnancy is safe and effective. RaioL et al. proposed that after adjusting for known risk factors, a cone biopsy depth of more than 10 mm in pregnant women is a decisive factor for premature birth. Therefore, the cone biopsy depth for pregnant women should be less than 10 mm, which requires a stricter selection of the indications for cone biopsy.

The pathology of cone biopsy must indicate whether the cutting margin is positive, whether the cervical glands are involved, and whether the lesion is multicentric.